Please be advised that today's conference is being recorded. I'd now like to hand the conference over to Edward Parker, Head of Investor Relations. Please go ahead.
Thank you, operator. Good afternoon, everyone, and thank you for joining Waystar's third quarter 2026 earnings call. Joining me today are Matt Hawkins, Waystar's Chief Executive Officer, and Alpana Wegner, Waystar's Chief Financial Officer. This afternoon, we issued a press release announcing our financial results and published an accompanying presentation deck. You can find these materials at investors.waystar.com. Before we begin, I would like to remind you that this call contains forward-looking statements, which are predictions or beliefs about future events or performance. Examples of these statements include expectations of future financial results, growth, and margins. These statements involve a number of risks and uncertainties that may cause actual results to differ materially from those expressed in these statements.
For a full discussion of the risks and other factors that may impact these forward-looking statements, please refer to this afternoon's press release and the reports we filed with the SEC, all of which are available on the investor relations page of our website. Any forward-looking statements made on this call are only as of today and will not be updated unless required by law. We will also discuss certain non-GAAP financial measures. These measures are intended to provide additional insight into our performance and should not be considered in isolation or as a substitute for financial information prepared in accordance with GAAP. We have provided reconciliations of the non-GAAP financial measures included in our remarks and the most directly comparable GAAP measures, together with explanations of these measures in the appendix of the presentation slide deck and our earnings release.
With that, I'd like to turn the call over to Matt.
Thanks, Edward, and good afternoon, everyone. Thank you for joining our third quarter earnings call. Waystar delivered another strong quarter. Revenue grew 21% year-over-year and 10% organically. Adjusted EBITDA grew 24%, with an adjusted EBITDA margin of 43%, and we generated $115 million in unlevered free cash flow. We ended the quarter with 1,488 clients generating more than $100,000 of trailing 12-month revenue, up 14% year-over-year. Commercial activity reflected healthy demand and robust bookings across the business. We are establishing larger, broader client relationships as large healthcare organizations increasingly look to Waystar to support more of the revenue cycle through a single connected platform. We made meaningful progress across our product roadmap, including new AI-powered and agentic capabilities that advance our vision of creating the industry's first autonomous revenue cycle.
This quarter reflects strong progress against our three execution priorities: driving broader adoption of the Waystar platform, extending our reach through partners and integrations, and advancing AI and innovation. First, driving broader adoption of the Waystar platform. We're expanding our relationships with existing clients and moving further upmarket with new clients. Our connected end-to-end platform gives us the opportunity to support the entire revenue cycle. Within our large client cohort, which we define as clients generating more than $100,000 in LTM revenue, the average client now uses approximately five Waystar product modules. With more than 30 modules across six product families, we see significant opportunity to continue driving broader platform adoption within these relationships. Second, extending our reach. We're expanding our distribution through strategic partners and deeper integrations that bring Waystar into more provider workflows.
Across our ecosystem of more than 200 channel partners, we have added more than 20 new integrations this year that expand our reach and create new opportunities for growth. Third, advancing AI and innovation. We're advancing our product roadmap across the Waystar platform, including expanding our position in the mid-cycle and bringing new AltitudeAI-powered and agentic innovations to market. Our near-term roadmap includes more than 20 planned AI capabilities, accelerating the autonomous revenue cycle vision to reduce manual work, automate increasingly complex tasks, and improve financial and operational outcomes for our clients. We delivered another quarter of strong commercial momentum. Year-to-date bookings grew 25% year-over-year, demonstrating continued demand and solid execution across the business. Let me bring that momentum to life with a few examples of what we're seeing in the market. This quarter, we secured the largest new client win in Waystar's history.
In a competitive process, a major East Coast health system representing approximately $7 billion in annual net patient revenue selected Waystar's full platform across patient access, mid-cycle, and backend revenue cycle operations. The organization plans to replace more than 20 separate vendors with Waystar as it simplifies its technology infrastructure and streamlines operations. We're also seeing strong momentum within our existing client base, which accounted for approximately 60% of our year-to-date bookings. One example is a large Texas-based health system that selected our Prebill Anomaly Detection solution. Expanding its relationship with Waystar and displacing two incumbent vendors. This organization already uses Waystar across claims management, patient access, and clinical documentation integrity, demonstrating our ability to broaden strategic relationships across the revenue cycle. This is also a great example of the opportunity we saw in bringing Waystar and Iodine together.
By combining Waystar's financial data, workflows, and connectivity with Iodine's clinical intelligence, we're creating differentiated capabilities that allow us to solve more complex problems for our clients and expand our relationships over time. We're seeing that strategy translate into strong commercial results. Iodine bookings exceeded our year-to-date plan by 74%. A key driver has been our go-to-market strategy of bringing together clinical documentation integrity, known as CDI, and Prebill Anomaly Detection to address a broader set of mid-cycle needs. Across these two solutions, we generated nearly $30 million of year-to-date bookings, including approximately $15 million in the third quarter alone, with a combined pipeline of more than $100 million. We're also seeing encouraging cross-sell momentum. Existing Waystar clients adopting Iodine capabilities contributed approximately $9 million of bookings in Q3, up 50% sequentially.
Taken together, these results demonstrate the opportunity we have to bring more of Waystar's capabilities to our installed base, expand our strategic client relationships, and drive durable growth across the platform. We're also extending our reach through strategic channel relationships, particularly across the ambulatory market. During the quarter, we expanded our partnership with a leading physical therapy practice management system, giving Waystar distribution into an additional segment of its client base. This expansion displaces three incumbent revenue cycle vendors and extends Waystar's reach to nearly 4,000 providers across more than 2,500 sites, representing approximately 17 million claims annually. Decisions like these reflect the trust we've built with channel partners, the breadth of our platform, and our ability to deliver real ROI. These wins demonstrate how our platform strategy is translating into competitive success.
We are winning large new clients, replacing fragmented incumbent solutions, and expanding relationships as clients and channel partners select Waystar to tackle more of their revenue cycle challenges. Our trusted, connected, and independent platform is built on four structural foundations we've discussed before: mission-critical infrastructure, proprietary data, an extensively deployed network, and deep domain expertise. Together, these strengths enable us to connect providers, payers, and patients across the revenue cycle. Our network continues to grow in both scale and depth. Waystar now processes more than 8.5 billion transactions annually, representing more than $3 trillion in gross claims. We connect approximately 1.5 million providers, and our clinical intelligence spans approximately one-third of U.S. hospital discharges. We continue to deepen our payer connectivity. In 2026, we've added more than 100 direct connections to health plans, supporting nearly 50 million transactions annually.
These deeper integrations increase the value of our network for clients and further strengthen Waystar's role as the connected financial operating layer for healthcare. We believe these advantages become even more valuable as AI accelerates across healthcare. We're moving beyond AI that identifies opportunities and recommends actions toward AI agents that can execute increasingly complex work on behalf of our clients. We continue to make meaningful progress advancing AI and innovation across the Waystar platform. As AI accelerates across healthcare, we believe the value of a trusted, connected, and independent platform becomes even greater. The revenue cycle doesn't operate within a single application. It spans providers, payers, patients, and thousands of financial workflows. Waystar is the system of action that sits at the intersection of those workflows.
One example is the industry's first autonomous claim resubmission capability, which we launched this quarter and is now in production as part of our premium claims management offering. Powered by AltitudeAI, the capability interprets payer responses, applies payer-specific intelligence to determine the next action, and autonomously resubmits eligible rejected claims with minimal human intervention. Based on early adopter results and the initial claim types supported, we estimate this capability could autonomously resubmit up to $5 billion in previously rejected claims annually, with the potential to eliminate more than 400,000 hours of manual work each year. For clients, that means lower administrative costs, faster reimbursement, and improved financial performance. For Waystar, we believe it creates opportunities to expand adoption of our premium offerings and drive additional transaction volume across the platform. We're putting AI to work in new ways across the Waystar platform.
More than 100 clients are participating in early access for conversational AI within our premium analytics offering. Clients can quickly analyze complex revenue cycle data by simply asking questions in natural language. Early adopters have reported up to a 75% reduction in time spent on data analysis. Mid-cycle is a strategic part of how we're expanding the Waystar platform. We're combining Waystar's financial data, payer intelligence, workflows, and connectivity with Iodine's clinical intelligence to bring greater automation earlier in the revenue cycle. As quality becomes an increasingly important component of reimbursement, we'll extend our Prebill Anomaly Detection capabilities into quality-related workflows, further connecting clinical and financial performance. We're seeing this innovation translate into commercial momentum. AltitudeAI-powered offerings represented approximately 43% of third-quarter bookings. More than 130 clients have joined our early adopter program, helping us test and refine new capabilities as we bring them to market.
We also saw strong client engagement at our recent Waystar True North conference, where a majority of surveyed attendees said they were more likely to expand the number of Waystar products their organizations use following the event. Taken together, these proof points reinforce our long-term opportunity ahead as we bring AI more deeply into the revenue cycle. To help lead this next phase, we recently welcomed Amit Khanna as our Chief Product and Technology Officer. Amit brings more than 25 years of enterprise technology experience, most recently leading healthcare at Salesforce, where he helped bring Agentforce for Health to market. His experience strengthens our ability to accelerate AI innovation and execute against our long-term vision. We're pleased with the progress we're making across our platform, product roadmap, and commercial execution. A key part of our strategy is signing larger, broader platform relationships, and we're seeing strong success here.
As we sign more of these larger deals, we are seeing implementation and revenue ramp periods that are longer than we originally anticipated. These relationships represent significant long-term revenue opportunities, with revenue building as clients implement and adopt more of the Waystar platform. Other factors are also affecting our near-term revenue outlook, which Alpana will discuss. We are confident in the underlying business and focused on translating our commercial momentum into low double-digit revenue growth while continuing to invest in the Waystar platform, operate with discipline, and deliver adjusted EBITDA margins of 40% or greater. Alpana will walk through our updated outlook, the near-term revenue dynamics, and how we're thinking about the business from here. Alpana, over to you.
Thank you, Matt, and good afternoon, everyone. It's great to be here for my first earnings call as Waystar CFO. Since joining Waystar, I've been impressed by the depth of the team, the strength of the Waystar platform, and the opportunity ahead. I'll start with our third-quarter results and then cover our updated outlook. Revenue was $326 million, an increase of 21% year-over-year. Organic revenue grew 10%, and as anticipated, reflects the approximately one point of pressure from three large client implementations that ramped unusually quickly in the prior year period. Subscription revenue was $181 million, an increase of 34% year-over-year. On an organic basis, subscription revenue grew 12%, reflecting continued strength in the core Waystar business. Volume-based revenue was $143 million, an increase of 8% year-over-year. Volume-based revenue improved from the second quarter and was in line with our expectations.
Provider revenue was $243 million, an increase of 28% year-over-year. On an organic basis, provider revenue grew 11%. Patient payments revenue was $82 million, an increase of 5% year-over-year, reflecting the shift from print to digital statements we have discussed throughout the year. Net revenue retention was 108%, consistent with our historical range, demonstrating continued expansion with our existing client base. As we execute our strategy to drive broader Waystar platform adoption, our large client relationships are becoming an increasingly important driver of our business. These relationships now represent approximately 75% of revenue, compared with roughly two-thirds just two years ago. We are seeing momentum across three indicators: growth in the number of clients, strong bookings, and expansion in our implementation backlog.
Specifically, clients generating more than $100,000 of trailing 12-month revenue increased to 1,488 during the third quarter, up 2% sequentially and 14% year-over-year. Year-to-date bookings from opportunities greater than $100,000 grew more than 30% year-over-year. Implementation backlog associated with these larger opportunities increased more than 50% year-over-year, and have grown at a mid-30% two-year CAGR. These trends are important because they provide visibility into the commercial activity that will contribute to future revenue growth. Larger, broader platform implementations naturally have longer revenue conversion times, which can extend to 12- 18 months. As we move through our planning process, we are focused on providing investors with greater insight into how the commercial momentum translates to recognized revenue. We expect to provide additional context with our formal outlook next quarter. Adjusted EBITDA was $139 million, an increase of 24% year-over-year, and adjusted EBITDA margin was 43%.
Adjusted EBITDA performance reflects continued operating leverage in our business, disciplined expense management, and gross margin expansion from efficiencies across the Waystar platform, and favorable revenue mix, inclusive of the shift away from lower-margin revenue. GAAP net income was $31 million, or $0.16 per diluted share. Non-GAAP net income was $87.1 million, and diluted non-GAAP net income per share was $0.44. Turning to the cash flow statement and balance sheet. Our business continues to generate strong, high-quality cash flow. Cash flow from operations was $104 million, and unlevered free cash flow was $115 million. Capital expenditures, including capitalized internally developed software, were $10 million in the quarter. We continue to invest meaningfully in our platform, AI, and automation capabilities as we advance our vision for the autonomous revenue cycle while maintaining strong profitability and disciplined investment across the business.
For modeling purposes, we currently expect capital expenditures for fiscal year 2026 to be $55 million-$60 million. As a reminder, we can have variability in capital expenditures from one quarter to the next, primarily due to timing of investments in our platform infrastructure. We ended the quarter with approximately $277 million of cash and short-term investments. Our net leverage ratio was 2.2x at quarter end, representing more than one full turn of leverage reduction over the past 12 months and ahead of the commitment we made. Our capital allocation priorities remain unchanged. During the quarter, we repurchased approximately $21 million of Waystar stock, bringing aggregate repurchases under our $200 million authorization to approximately $33 million through September 30th.
We continue to be focused on investing organically in the business, complemented by selective M&A, maintaining a disciplined balance sheet through debt reduction, and returning capital shareholders through our share repurchase program. Turning to our outlook, we now expect full-year revenue of $1.277 billion-$1.287 billion, with a midpoint of $1.282 billion. This implies fourth-quarter revenue of approximately $323 million and revenue growth of approximately 6%. I want to walk you through the three dynamics that are informing and shaping our expectations for Q4. First, the impact of the transition from printed patient statements to digital delivery within our patient payment business has increased from our expectations earlier in this year. We continue to view the shift towards digital as the right long-term direction for providers, patients, and Waystar. Digital delivery offers a better patient experience and more attractive unit economics.
Second, the mix of commercial activity for Iodine has shifted towards Prebill Anomaly Detection, where implementation and the performance-based revenue model create a longer period between booking and recognized revenue. As a result, we are seeing lower levels of revenue from Iodine than previously anticipated in full year 2026. Importantly, our view of the strategic opportunity and our expectations for the accretion in fiscal year 2027 are unchanged, given the strong commercial momentum we're seeing in Iodine bookings and increasing demand for Prebill Anomaly Detection. Third, our fourth-quarter growth comparison reflects three large client implementations that ramped unusually quickly in the prior year period. Taken together, these three factors will impact our expected revenue growth rate for the fourth quarter by approximately four points. Without these three factors, our normalized fourth-quarter growth rate would be approximately 10%.
On a full-year basis, our guidance at the midpoint implies normalized organic revenue growth of approximately 11%, consistent with our low double-digit long-term growth target. Importantly, many of the comparison dynamics we've discussed throughout 2026 will roll off as we exit the year, providing a cleaner underlying comparison going forward. As a reminder, consistent with prior years, we typically see seasonally lower patient payment volumes in the fourth quarter compared with the third quarter as patients meet their high-deductible health plans. Turning to profitability, we are raising our full-year adjusted EBITDA outlook to $543 million-$549 million, with a midpoint of $546 million, an increase of $6 million from our prior midpoint. This implies fourth-quarter adjusted EBITDA of approximately $135 million, representing a margin of approximately 42%, and full-year EBITDA margin of approximately 42.5% at the midpoint.
Our margin reflects the scalable nature of our platform and disciplined cost management, balanced against planned ongoing investments in advancing AI and innovation. In closing, we delivered strong third-quarter results and executed across our strategic priorities. The commercial traction we are seeing reinforces the strength of our competitive position, our underlying business, and the opportunity ahead. The revenue dynamics we discussed are largely driven by timing and year-over-year comparisons, rather than changes in underlying demand. We believe this distinction is important in understanding our near-term performance. Looking ahead, our focus remains on converting strong bookings and expanding backlog into durable revenue growth while maintaining our financial discipline and profitability. We are confident in our long-term opportunity and strength of our financial model. With that, operator, we are ready to take your questions.
As a reminder, if you would like to ask a question at this time, please press star one one on your touch-tone phone and wait for your name to be announced. To withdraw your question, please press star one one again. Our first question comes from Brian Peterson with Raymond James.
Oh, hey, guys. Thanks for taking the question. I maybe just wanted to start on some of these really strong bookings numbers that you gave. Matt, those are well above your normalized growth rates that you called out that are in the low double digits. Can you kind of just walk us through the disconnect between the bookings and the revenue growth? I know there is going to be some variability on implementations, but bookings is the best leading indicator, so just kind of want to understand how that is going to translate into the revenue growth going forward.
You bet. Yeah. Thanks, Brian. We are really pleased with the year-to-date bookings growth, as we highlighted in the prepared remarks, 25% year-over-year growth, including the largest new client win in our company history. We are seeing really nice install base growth, so we are growing with existing clients. We are pleased with that. And that is, as you said, that is leading to large client implementation backlog of 50% year-over-year growth. So, it is the front portion of that, the bookings converting to backlog, contracted backlog, now looking ahead to converting that to revenue, gives us confidence in our long-term low double-digit revenue growth rate. I would just say qualitatively, and then I will turn it to Alpana for perhaps a comment, we are seeing strong demand. We are not seeing a change in the competitive environment or our win rates, and we are pleased with that.
What our focus is on is converting these larger bookings, which, as we've highlighted, tend to have longer implementation ramp time. This is in part because a client who's joining us, especially if they're larger, they may have their own planning cycles, so they're selecting a vendor well in advance of when they're actually going to implement software. We can implement very rapidly, and we have a dedicated team of people focused on ramping that implementation to realize revenue as quickly as possible. That's the phenomenon that we're experiencing. I just would summarize by saying a lot of confidence and a sense of momentum as we convert sales activity to strong bookings results, and now as we move that through the system, we're excited about the long-term double-digit opportunity to drive revenue.
Great. Thanks, Matt. Maybe just to follow up, Alpana, did you size the impact of the shift from print to digital? I appreciate that's a better way to address value for customers, but any help on what that change in mix could potentially be going forward? Is this something that we should expect to continue into 2027 and beyond? Thanks, guys.
Yeah. Thanks, Brian, for the question. From a sizing perspective, what I can share with you is, as I mentioned, we see a couple of dynamics in Q4, largely timing and year-over-year comp. One of them is this print-to-digital shift that we're seeing. I would say that from a long-term perspective, we see our customer base continuing to use both print and digital. So, we see this as a quarter of volume variability that we're seeing in the near term. But from a longer-term perspective, I would say that what we've been talking to you about all year has not changed, which is we continue to see a mix there taking place, and we've got solutions in the market that are there to meet the demand from a digital perspective as well.
I think, as you know, we also see this as being very margin-friendly to us in terms of that shift being in the near term, contributing from margin, but even longer term, seeing that being accretive to our business.
Right. I would add, Alpana, I would add that we view this as a multi-year transition. This isn't something that is more sudden than that. We view it over several years, and we have solutions that address both. The important thing is the value of keeping the provider connected to the patient in the way they want to be communicated to, and in order for that provider to help the patient understand financial responsibility and secure payment from that patient.
Our next question comes from Ryan Daniels with William Blair.
Yeah, congrats on the strong bookings performance, and thanks for taking the questions. Appreciate the new metrics as well. I don't know if that's Alpana or Ed, but really appreciate that. I guess one of the questions is going to be in regards to the bookings strength. I'm curious if you're seeing customers buying more modules at once, and that's driving this uptick in larger bookings, or are you seeing kind of larger clients with higher net patient revenue, like the example you gave of the $7 billion client coming into the funnel and converting to bookings? Which of those two is kind of more impactful for the growth algorithm?
Thanks, Ryan. We see it as both, actually. We're focused on offering more of our platform at the outset. As you'll recall, we have a robust sales discovery process where we really try to understand what the needs of the prospect or the client are, and increasingly, we're promoting or showing more of the Waystar platform at the outset. So that's often leading to more solutions packaged together. It's great that we have solutions across the front, middle, and back, and as we showcase the strong ROI we're able to deliver, we're excited about the phenomenon of having clients or prospects select us and then replace the point solutions that they have been using with a single platform approach. So, that's one thing.
The other thing is we're calling on larger accounts. Because we do, and because of our robust discovery process, we go into these accounts, we understand what their current operating metrics look like, and then we're able to call those accounts. Certainly, we're promoting more of the Waystar platform and packaging those solutions, but it's still often the case that just because the account is larger, they may be working across multiple facilities, and that's often contributing to the stronger and higher average sale size.
Yeah, Ryan, Alpana here. I would just share a couple other points there, just to underscore the opportunity from a cross-sell. We did share that the larger customers who we do see as having both strategic value from a long-term retention perspective as well as expansion opportunities, what we see today in that client base of the larger clients that are over $100,000 is on average five products, which against a portfolio of 25+ products across six categories, we see as having meaningful cross-sell opportunity as well. Just to connect back, and I will take credit for the metrics over Edward over here, but just to connect it back to a few of the metrics that we shared with you today.
All right. Well, we do appreciate it. Look forward to some other new ones when we get the guidance. I'll hop back in the queue in the interest of time. Thanks.
Thanks, Ryan.
Our next question comes from Stan Berenshteyn with Wells Fargo Securities.
Hi. Thanks for taking the questions. Matt, maybe stepping back a bit from the quarter's results, I'm wondering how are providers approaching large outsourcing contracts now that AI can do more of the work? When you are competing against those vendors, are you seeing any of your wins replacing outsourced labor?
Thanks, Stan. What I'd say is, we think that the outsourced portion of the market is somewhere between 15% and 20% of the total market today. The insourced part of the market tends to be the remainder. Included in the insourced part of the market is technology and labor spend, as you know. What we would see, we don't necessarily see those outsourced vendors showing up in the insourced side. We have relationships with several of them, so as they attempt to grow, we would grow with them, which we're grateful for. What we are seeing is that AI definitely expands the Waystar opportunity. When you think about how we view the market ahead of us, we believe that the big unlock is that AI can replace more and more labor, so that expands the addressable market for us.
As you look over the longer term, that's what is causing most of our excitement. So, we can grow with the outsourcers as they use our solutions internally in their organizations. We don't necessarily see a competitive dynamic shift in the market that we're pursuing today, and we see longer term the opportunity for us, even on the insourced side, to displace labor that is resident inside these provider organizations with intelligent AI-powered capabilities that lead to smarter solutions, higher return on investment, and overall lower cost to collect. So, that's our focus.
Got it. Just as a quick follow-up, just in terms of bookings, obviously strong performance that you called out, but can you maybe share how much of your bookings came from channel partners versus more of the internal sales efforts? Thank you.
We don't necessarily disclose the portion that comes from channel partners. Stan, what I would highlight is, most of our channel partner relationships tend to be on the ambulatory side of the market versus the acute side of the market. We feel like part of our addressable market is reachable because of the really strong channel partner relationships that we do have. I would characterize, without disclosing specifically, I would characterize that we do have strong channel partner relationships and a fair amount of the ambulatory-oriented sales bookings come through a trusted channel partner relationship.
Got it. Thanks so much.
Our next question comes from George Hill with Deutsche Bank.
Good morning, guys. Good afternoon, guys. Thanks for taking the question. Alpana, I will echo my thanks on the new metrics, especially the product density metrics, which I know me and a lot of investors have been looking for. My question is, given the bookings and backlog growth that you guys discussed, is there any reason why 2027 growth shouldn't be at least in line with the company's long-term growth algorithm, if not faster, given kind of the step-down in Q4 expected growth? Thank you.
Thanks for the question, George. How I would think about 2027 is, we've shared in my comments, we are still in the planning process, and we're still reviewing our overall view of 2027. I am happy to have just anniversaried my first 90 days, and I'm, as you can imagine, spending a lot of time on 2027. The things that are shaping our thinking around 2027 are exactly what you've commented on. What do we have in contracted backlog? What do we have in bookings momentum and the pipeline and the demand? I did share we see Iodine being accretive in 2027, and so that is also shaping our thinking, as well as what we're seeing from a shift mix in print to digital.
That all to be said, right now, our focus is finishing Q4 strong and making sure we deliver against our commitments and execute well against the business priorities. I'm very much looking forward to next quarter coming back with a view of 2027 with some better or some more complete context and color around the growth drivers.
Thank you.
Our next question comes from Michael Cherny with Leerink Partners.
Good afternoon. Thank you for taking the question. Maybe if we could just dive in a little bit on the growth dynamics. Iodine, I hear you on some of the components related to the timing and elongation of revenue recognition. How do you get visibility into that getting better? If you could dive a little bit more into the why behind it, that would be great. Thanks.
Yeah. I will maybe start, and then Matt, please do add on. In terms of what gives us confidence and visibility into Iodine, I would share with you a couple of data points. One is, we see strong bookings and demand. That demand is through the pipeline. As we shared, $30 million of bookings through the first nine months of the year is exceeding our expectations. That is 74% above plan. Having the contracts booked and sitting in backlog give us a reasonable amount of visibility into our thinking around Iodine and, in particular, around 2027. As Matt shared, we also see the demand continuing with $100 million of pipeline, and we have got several strategic go-to-market motions underway to optimize against that demand. That is really the question of the why. The why is we are viewing this as a long-term strategy and execution.
We view it as there is packaging and opportunity right now, particularly as we see mid-cycle demand, to combine CDI and our Prebill Anomaly Detection offering. The combination of those two are naturally elongating a bit of the cycle time from bookings to revenue, but we continue to be confident around 2027 and the accretive value and the underlying thesis of the Iodine acquisition.
Yeah. We are really starting to see the cross-sell motion pick up. That was another key part of our original thesis, as Alpana was alluding. That $100 million of go-forward pipeline of opportunity, that is the behavior that we have wanted to see that we believed was possible as we identified a tremendous cross, a bilateral cross-sell, Iodine solutions into Waystar clients and Waystar solutions into Iodine clients. We highlighted an example of that in our prepared remarks. So, feel good about the position of Iodine and now the way that it unites our whole platform.
Our next question comes from Elizabeth Anderson with Evercore ISI.
Hi, guys. Good afternoon, and thanks so much for the question. Can you talk to us a little bit more about the margin strength? I know you have talked about some timing elements and some of the cost savings running ahead of some of the planned reinvestment, but that seems to be consistently the case. So, I guess, can you help us think about how you think about those as a jump-off point and if there is any sort of triggers that might change that in terms of investment spend? Thanks.
Yeah. It is good to talk to you, Elizabeth. And margins is definitely a place in which we want to continue to be very intentional and disciplined around how we think about the profitability profile as we continue to invest in growth. What I would say is our long-term target of EBITDA margin of 40%+ continues to be our target, that we are investing from a position of strength today in terms of how we see the profile of business. And those investments are very intentional in terms of our priority around organic growth. So, the places that we are investing right now really are in product, in AI, and in innovation. As Matt talked about, we have got several new features, functionalities, and capabilities in market, and that is evidence of where we have been prioritizing the spend.
I do see a continued opportunity to see efficiencies in optimizing our operating costs, and so we'll continue down that path. But right now, we see the current profile being healthy, strong, and in line with our overall long-term targets.
Thank you.
Our next question comes from Alexei Gogolev with JP Morgan.
Hello, everyone. I wanted to ask about the NRR. It remained at 108% this quarter. What are the biggest factors keeping NRR at this level today, and what do you see as the clearest path to moving it back towards the higher end of your historical range?
Yeah. Alexey, thanks for the question. We do view the 108% this quarter as being healthy in terms of where within our range we would want NRR to be. We have shared that our longer-term range is that 108%-110%. Underpinning that continues to be strong GRR of 97%. As I mentioned earlier in the call, we see extensive and a very significant expansion opportunity. As I think about your question of where do we see the opportunity of getting from where we are today, 108%, to something higher, we see it in particular around expansion. As I shared earlier, that large customer cohort of ours that is over $100,000 in revenue today, on average, has about five products per customer.
When we look forward and we see the amount of backlog and bookings momentum in that cohort, we see a mix of both new business as well as expansion opportunity, and would expect that to impact and influence the 108% NRR consistent with our broader growth algorithm that we have shared longer term.
Thank you, Alpana.
Our next question comes from Brian Tanquilut with Jefferies.
Hey, good afternoon, and welcome to the call, Alpana and Matt. Matt, when you talk about the near-term roadmap having 20 planned AI capabilities, does that translate to new SKUs? Or said differently, how should we think about Waystar's AI capabilities contributing to revenue growth? Is that just upselling new SKUs, or is that allowing you to just price the additional value?
Thanks, Brian. It's both. We are offering and have launched a few brand-new SKUs, including our recoupment product, our Prebill Anomaly Detection solution, and we have other exciting SKUs in our mix, and we look forward to launching those. Those create new revenue moments for us that can be cross-sold into our install base. It's one of the advantages of having the scale that we do, is we have a massive distribution engine that we can create something new and take it, new AI capability, take it to our install base of clients. I just would add a quick comment. AI, it needs a place, it needs somewhere to act. When we talk about Waystar's platform being the financial execution layer, as we deliver new SKUs, that are AI-powered, we can turn them on our platform and distribute those rapidly. We're excited about that.
We also have a premium approach. In addition to new SKUs, we'll take current modules of ours and supercharge them with AI capability, and then we'll charge a premium for those solutions. AltitudeAI has several examples of that as well, in our claims management suite, in our prior authorization capability, in our eligibility automation capabilities. Those are all our denial and appeal management solution. Those would be examples of modules of ours that we've supercharged with AI, that we've created a premium offering for that AI-powered solution. When we think about monetization overall, it is a function of new SKUs, it's a function of premium versions of software capability, and then it's also things that drive retention and elongate a relationship with the client and allow us to price to value.
I'd say the last thing that I would highlight is an example of a volume-oriented AI-powered solution, our Prebill Anomaly Detection product. That's a solution that identifies anomalies, and in a cohort of 10,000 discharges, we find millions of dollars of anomalies that the AI corrects and identifies and delivers to the client. That's an example of a volume-based relationship, a performance-based relationship that's focused on the outcome. We have that capability within the AI-powered solutions that we're delivering to market.
Awesome. Thank you.
Thank you.
Our next question comes from Richard Close with Canaccord Genuity.
Yeah, thanks for the questions, and congratulations. Just maybe to dive in deeper in terms of the anomaly, you were just discussing that, but just with respect to the Iodine impact that you cited for the fourth quarter, I just want to better understand exactly what is going on there. Is that a different revenue model than you previously thought about on CDI, or just specifically what has changed and maybe what the expectations were before would be helpful?
Sure. Richard, we price the CDI offering on a subscription basis in the vast majority of the clients that we serve there. As we were uniting the business, it has been a very fast and important year for us to integrate Iodine with Waystar. One of our core initiatives that we were excited about was Iodine had been working on a Prebill Anomaly Detection solution, and initially had planned to launch that last Q4 of 2025. We made a tough decision at the time, but we made the decision to pause the launch of that pre-bill solution so that we could add financial and administrative and payer-related insights to the clinical data that was comprised to drive the value in the Prebill Anomaly Detection solution. We really strengthened that offering.
We also made the decision in learning about the market and what the market expected to instead of pricing pre-bill as a subscription, we would price it on a performance basis. So we would price it based on the outcomes that it generates, and the solution, the found revenue dollars or found changes that could be made to improve the accuracy of a claim. So we made the decision to price our Prebill Anomaly Detection solution on that basis because we see some competing offerings in the market that are also priced on an outcomes or a performance basis as well. Feel like we have a very strong product offering. So the thing that we highlighted in our Q4 commentary is that we are very pleased with the robust bookings that we are driving. We are pleased with the pipeline of opportunity that we have, as you have heard us say.
As we implement the solution, we are finding that because it is a performance-oriented revenue model, it is taking us slightly longer to actually convert that implementation to revenue. Is there anything you would add to that, Alpana?
Yeah, the-
That's the focus.
The only thing, Richard, I would add is just in terms of Q4 itself, what changed or what has shaped our view as it relates to Q4 specifically, it's really, as Matt just mentioned, the momentum we're seeing in Prebill Anomaly Detection and extending that to CDI. We, in the quarter, made a strategic go-to-market decision and executed on it based on the demand we're seeing to package those together.
Yeah.
The combination of those two in the near term is creating just a slight incremental shift in timing. This is really about timing and just in the near term in Q4, because we continue to see Iodine on a combined basis accretive in 2027.
Yeah, I think it was really important for us to share with you the demand environment and the momentum that we're seeing there so you could get the same sense as we do. Now we have a dedicated team of people focused on implementing that and ramping these solutions to revenue realization through the performance criteria.
If I could ask a follow-up on that, have you tested the performance-based portion of this in terms of against any past claims that you feel extremely confident you're going to be able to achieve the performance metrics in order to recognize that revenue?
The short answer to that, Richard, is yes. We've got some early adopters that have already begun to start transacting with us. We are seeing the outcomes in line with our initial estimates as it related to those early adopters, which is giving us further confidence on the longer-term outlook.
I would say as we expand the cohort of clients that we're bringing live on the solution, it actually strengthens the product. We're finding more and more because of the data that we're able to use and the data science associated with it, the AI associated with it, we're finding more revenue dollars for the client and more anomalies avoided, and that bolsters the product. Yes, we have conviction that we have a strong product offering.
Great. Thanks.
Our next question comes from Ryan Halsted with RBC Capital Markets.
Good afternoon. Thanks for taking the question. Maybe just sticking with this topic, should we be assuming that most of the Iodine bookings is going to be priced on this basis, and should we be thinking about the timing, the ramp time to be following in the same cadence as you are describing for the Prebill Anomaly Detection, or are various models being priced differently? If so, would love to get a little bit of more color as to your visibility in ramp time for the rest of the Iodine offerings. Appreciate the clarification.
Yeah. Not a problem. From a clarification perspective, I would say we do have multiple models in market as an offering, but the model in which Matt just articulated in terms of outcome-based is the one that we are seeing certainly in the bookings as well as in the pipeline, getting the greater traction and getting stronger momentum. I would say that we are, in a directional sense, I would say that the majority is in the outcome-based pricing model. In terms of what gives us then confidence and conviction around, how are we going to see this translate? Like I just mentioned, we have got some early adopters that we have got some positive signals off of, as well as we do continue to see the models getting smarter and continuing to give us returns in terms of indicators on performance that would underpin our continued confidence in it.
Got it. Appreciate the clarification.
Just to round that out, other products, utilization management and CDI, tend to be subscription-type products. Prebill Anomaly Detection is a performance outcome-oriented product.
Got it. Okay, thanks.
Our next question comes from Charles Rhyee with TD Cowen.
Yeah, thanks for taking the question. If I could maybe ask the question a little bit differently, which is, if we are having this outcomes-based pricing and you have signals for next year, is that fair to think then we should have maybe more outsized growth related to Iodine next year, as the revenues are starting to get recognized for the implementation that we already have? Secondly, are we carrying costs related to deploying these solutions such that, because when I look at the EBITDA guide for the rest of the year, it looks like the implied Q4 range is a little bit lower consensus and is down sequentially. Just curious if that is what is kind of driving that for EBITDA as well.
Yeah, thanks, Charles. I will tackle both of those. On Iodine, the way that I would think about it is, we are not giving formal guidance on 2027. We are going to wait until our normal cadence to do that. But in terms of the contribution, we do see Iodine being accretive, and I say, as I just mentioned, Prebill Anomaly Detection is where we are seeing tremendous amount of demand, strength, and bookings coming from, and that is on this outcome base. In terms of outsized, hard to say in terms of how you think about what is right-sized versus outsized, but what I would say is we see a path and have line of sight to Iodine being accretive in 2027.
As it relates to EBITDA margins, I would say we do not look at this from a We are not optimizing to a particular quarter. What you are seeing in Q4 is the timing related to Iodine. You are also seeing a bit of timing relating to natural spend that comes towards the end of the year. We feel confident in the 43% EBITDA margin on a full-year basis, and that is how I would think about the EBITDA margin profile.
Great. Thanks. If I could just have one follow-up. You mentioned, right, some of the factors impacting revenue. One was the lapping of three large, faster-than-expected implementations in 2025. Does any of that carry into the first part of next year? I am just trying to recall if some of that impacted 1Q of 2026 such that we would have a tough comp in 1Q of next year. Thanks.
Yeah. As I look forward to 2027, I see much of the year-over-year comp-related challenges that we have had in 2026 that we have spoken to throughout the year being behind us, and we look forward to sharing maybe a bit of a cleaner, simpler view as we go into 2027.
Great. Thank you. Helpful.
Our next question comes from Jailendra Singh with Truist Securities.
Yeah, thank you, and thanks for taking my questions. You've given a lot of detail on the headwinds affecting the fourth quarter revenue outlook. On the flip side, what are the potential upside drivers you think could happen in Q4? I mean, could faster implementation activity, like stronger transaction volumes, or maybe better conversion of the existing backlog? Which of these drivers do you have the greatest visibility into today?
Hi, Jailendra. Yeah, we'd say we're always focused on converting the strong demand and strong bookings and continued expansion within existing clients and larger platforms that we see to revenue. We have dedicated teams focused on finding incremental opportunities to perform better than what we're communicating and to create upside to our plan. I just would reinforce what we've highlighted is mostly a timing and a mix issue in Q4, but we're always looking to do better than. We want to kind of call it like we see it. We're focused on performing in Q4 and setting ourselves up for a strong 2027 and a go-forward plan.
Okay. Thanks a lot.
Thank you.
Our next question comes from Steven Valiquette with Mizuho Securities.
Oh, thanks. Sorry for my raspy voice, slipping under the weather here. But just another quick question on EBITDA. Wanted to focus just a bit more on the EBITDA dollars as opposed to EBITDA margins. I think the last four years in a row, you had a sequential increase in EBITDA dollars in the calendar fourth quarter each year versus the calendar third quarter. Obviously, for 2026, you are guiding for EBITDA dollars to be down sequentially. I think you just talked about the reasons why in one of the questions a couple of minutes ago. But I guess the question is really, is that the normal seasonal pattern? Should we expect that in years going forward that 4Q will go back up? And also, what is the single biggest factor driving that lower sequential EBITDA among all the things you mentioned? Thanks.
Yeah. Thanks for the question. I'd say a couple things there in terms of how we're thinking about Q4 EBITDA. The answer to the question on the single largest factor, I would say, is the top line near-term variability that we're seeing. The print to digital certainly is a lesser impact to the margin than, for example, the Iodine timing, as it is a much higher margin. So I'd say the mix of products there is being reflected in the EBITDA line. The other thing I would say is, all year we've been looking to continue to invest from an AI and product perspective. We are not necessarily optimizing for one quarter is how I think about it.
I look at it more on a full year and on an annualized basis, and being at the 43% at the midpoint of our guidance, I think would be reflective of how we think about EBITDA margins going forward.
Yeah.
That concludes today's question-and-answer session. I'd like to turn the call back to Matt Hawkins for closing remarks.
Well, thank you all for joining us today. We're pleased with the results in Q3. It's a testament to a strong and robust business with a good demand environment that we're converting to commercial momentum. We're very appreciative of our team for working so hard to taking care of our clients, and we look forward to being in touch with you all, and thank you for your time today.
This concludes today's conference call. Thank you for participating. You may now disconnect.